鳃裂囊肿及瘘管199例临床病理分析

Clinic Pathological Analysis of 199 Patients with Branchial Cleft Cyst and Fistulas

目的:回顾性分析鳃裂囊肿及瘘管的临床诊治经验及病理学特征。方法 :对2007-01—2011-08我科有详细记载的199例鳃裂囊肿及瘘管(其中鳃裂囊肿168例,鳃裂瘘管31例)的临床特点、组织病理学、诊治方法及预后进行分析和讨论。采用SPSS 15.0软件包的χ2检验进行统计学分析。结果:第一鳃裂囊肿及瘘管80例(占40.2%),第二鳃裂囊肿及瘘管106例(占53.3%),第三鳃裂囊肿及瘘管3例(占1.5%),第四鳃裂囊肿及瘘管10例(占5.0%)。所有患者均行病理学检查,诊断符合鳃裂囊肿或鳃裂瘘管(1例伴发腮腺多形性腺瘤,1例伴发腮腺腺淋巴瘤,1例伴发腮腺乳头状囊腺瘤,1例伴发结核);继发感染者有100例;轻度异常增生者有11例。86例患者行免疫组织化学分析,以CKp+最多(60例,占69.8%),其次为同时CKp+、CK8+者(12例,占14%)。合并瘘管者31例(13例有内外瘘口,18例仅有外瘘口)。所有患者均手术切除肿物及瘘管,有内瘘口者均追踪到内瘘口予以切除并结扎,随访3～48个月,失访率为19.6%(39/199),复发率为5.6%(9/160)。结论:第一、二鳃裂囊肿及瘘管最常见,鳃裂囊肿由于其临床分型的多样性及位置的多变性,明确诊断常需借助组织病理学检查;鳃裂瘘管诊断常较明确,手术切除是主要方法,对内瘘口的处理尤为重要,但应注意手术时勿损伤周围重要组织。

Objective： The aim of this study was to approach the clinical and pathology of the branchial cleft cyst and fistula. Methods： The clinical feature, histopathology, diagnosis, treatment and prognosis of 199 patients （168 branchial cleft cysts and 31 branchial cleft fistulae） in our department between Jan 2007 and Aug 2011 were reviewed. SPSS 15.0 software package was used for X2 test. Results： There were 80 first branchial cleft cysts, 106 second branchial cleft cysts, 3 third branchial cleft cysts and 10 fourth branchial cleft cysts. There were 100 patients with infection, 11 patients with slightly paraplasm, all patients with histopathology exam （1 case with pleomorphic adenoma; 1 case with adenolymphoma; 1 case with papillary cystadenoma; 1 case with tuberculosis）, 88 patients with immunohistochemisty （69.8% were CKp＋; 14% were CKp＋ and CK8＋）and 31 patients with fistulas （13 cases had exterior and interior orificium fistulae; 18 cases had exterior orificium fistula only）. Complete surgical extirpation was the only treatment of choice and it is much important to eliminate the interior orificium fistula especially. During the follow-up period, 19.6% （39/199） of patients had withdrawed and 5.6% （9/160） of patients had recurrence. Conclusion： First and second branchial cleft cysts and fistula are the most common lesions. It affected much more to the patients due to its diversity and polytropy. Diagnosis needs histopathology. It＇s consequential to excise the cyst and orificium fistula completely. Important tissues must be protected in surgical procedures.